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. 2020 Sep 30;9(10):3178.
doi: 10.3390/jcm9103178.

Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up-Results from a Poland's National Health Fund Program of Comprehensive Post-MI Care-A Population-Wide Analysis

Krystian Wita  1 , Andrzej Kułach  2 , Jacek Sikora  3 , Joanna Fluder  4 , Ewa Nowalany-Kozielska  3 , Krzysztof Milewski  5 , Piotr Pączek  6 , Henryk Sobocik  7 , Jacek Olender  8 , Lucjan Szela  8 , Zbigniew Kalarus  9 , Pawel Buszman  10 , Piotr Jankowski  11 , Mariusz Gąsior  3   12
Affiliations

Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up-Results from a Poland's National Health Fund Program of Comprehensive Post-MI Care-A Population-Wide Analysis

Krystian Wita et al. J Clin Med. .

Abstract

Introduction: Advances in the acute treatment of myocardial infarction (AMI) substantially reduced in-hospital mortality, but the post-discharge prognosis is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI) is a program of Poland's National Health Fund that aims at comprehensive post-AMI care to improve long-term prognosis. The aim of the study was to assess the effect of MC-AMI on all-cause mortality in one-year follow-up.

Methods: MC-AMI includes acute MI treatment, complex revascularization, cardiac rehabilitation (CR), scheduled one-year outpatient follow-up, and prevention of sudden cardiac death. In this retrospective observational study performed in a province of Silesia, Poland, we analyzed 3893 MC-AMI participants, and compared them to 6946 patients in the control group. After propensity score matching, we compared two groups of 3551 subjects each. To assess the effect of MC-AMI and other variables on mortality, we preformed a Cox regression.

Results: MC-AMI was related with mortality reduction by 38% in a 12-month observation period and the effect persisted even after. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with 1-year mortality (HR 0.52, 95%CI 0.42-0.65, p < 0.001). Besides that, older age (HR 1.47/10 y), ST-elevation AMI (HR 1.41), heart failure (HR 2.08), diabetes (HR 1.52), and dialysis (HR 2.38) were significantly associated with the primary endpoint. Among MC-AMI components, cardiac rehabilitation (HR 0.34) and strict outpatient care (HR 0.42) are the crucial factors affecting mortality reduction.

Conclusions: Participation in MC-AMI reduced 1-year mortality by 38% and the effect persisted after the program had been completed.

Keywords: cardiac rehabilitation; cardiovascular prevention; mortality; myocardial infarction; post-infarction prognosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart. MC-AMI: Managed Care in Acute Myocardial Infarction, PCI: percutaneous coronary intervention, CABG: coronary artery by-pass grafting, ICD: implantable cardioverter defibrillator, EF: ejection fraction, CRT-D: cardiac resynchronization therapy-defibrillator.
Figure 2
Figure 2
Kaplan–Meier curves showing freedom from all cause mortality—propensity score matching—12-month follow up analysis for the entire study group (7102 subjects). Follow-up extended to 24 months showing persistent effect after the program had been completed. MC-AMI: managed care after acute myocardial infarction.
See this image and copyright information in PMC

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References

    1. Schmidt M., Jacobsen J.B., Lash T.L., Bøtker H.E., Sørensen H.T. 25 years trends in first hospitalization for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: A Danish nationwide cohort study. BMJ. 2012;344:e356. doi: 10.1136/bmj.e356. - DOI - PMC - PubMed
    1. Smolina K., Wright F.L., Rayner M., Goldacre M.J. Long-term survival and recurrence after acute myocardial infarction in England, 2004 to 2010. Circ. Cardiovasc. Qual. Outcomes. 2012;5:532–540. doi: 10.1161/CIRCOUTCOMES.111.964700. - DOI - PubMed
    1. Freisinger E., Fuerstenberg T., Malyar N.M., Wellmann J., Keil U., Breithardt G., Reinecke H. German nationwide data on current trends and management of acute myocardial infarction: Discrepancies between trials and real-life. Eur. Heart J. 2014;35:979–988. doi: 10.1093/eurheartj/ehu043. - DOI - PubMed
    1. Townsend N., Wilson L., Bhatnagar P., Wickramasinghe K., Rayner M., Nichols M. Cardiovascular disease in Europe: Epidemiological update 2016. Eur. Heart J. 2016;37:3232–3245. doi: 10.1093/eurheartj/ehw334. - DOI - PubMed
    1. Gale C.P., Allan V., Cattle B.A., Hall A.S., West R.M., Timmis A., Gray H.H., Deanfield J.E., Fox K.A.A., Feltbower R. Trends in hospital treatments, including revascularisation, following acute myocardial infarction, 2003–2010: A multilevel and relative survival analysis for the National Institute for Cardiovascular Outcomes Research (NICOR) Heart. 2014;100:582–589. doi: 10.1136/heartjnl-2013-304517. - DOI - PubMed

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